THINK.CHANGE.DO
A MEDICATED NATION
Prof S.I. (Charlie) BenrimojHead Graduate School of Health
& Prof of Pharmacy Practice
September 2011
Major Points : Medications Cheapest form of therapeutic treatment Benefits but also risks At least 2% to 4% of hospital admissions are drug
related (75 years or over greater 30%) 50 to 60% of patients are non-compliant Patients taking multiple medications (PolyPharmacy) at
risk Pharmacist can reduce medication costs, reduce
morbidity and mortality
Demographic Changes & Disease Patterns & Consumer expectations
Increase in no of people with complex chronic disease
Many will be elderly and have multiple health problems
Shift to self management Increase to health
promotion and disease prevention (increased demand for screening)
Increased demand for access to health services
Health and Disease Patterns
Prevention Disease changing definition Detection of disease New diseases Risk factors
(obesity, physical inactivity) Better management leading
to longer survival
Source: AIHW (2004). Australia’s Health. Canberra: AIHW
National Medicines Policy
Quality of Use Equity o f Access
High Quality Products& T imely Introduction
A V iablePharm aceutical Industry
PHARMACEUTICAL BENEFITS SCHEME - 2007 to 2010: Number of Prescriptions
Source: Expenditure and prescriptions twelve months to 30 June 2010 PBS
Jan-07 Jan-08 Jan-09 Jan-10160
165
170
175
180
185
millions
PHARMACEUTICAL BENEFITS SCHEME - 2007 to 2010: Government Costs
Source: Expenditure and prescriptions twelve months to 30 June 2010 PBS
Jan-07 Jan-08 Jan-09 Jan-104000
4500
5000
5500
6000
6500
7000
7500
millions $
9.3%
PHARMACEUTICAL BENEFITS SCHEME - 2007 to 2010: Government and Patient Costs
Source: Expenditure and prescriptions twelve months to 30 June 2010 PBS
Jan-07 Jan-08 Jan-09 Jan-102000
3000
4000
5000
6000
7000
8000
9000
22 million Australians (2009)
8.3 medications per person (excludes private prescriptions and below $34.20 for general)
$316 per person cost Government
Source: Expenditure and prescriptions twelve months to 30 June 2010 PBS
Questions: Cost effectiveness?
- Improve compliance As well benefits of medication how can we
minimise the negative clinical outcomes ?- Medication Management reviews- Monitoring Adverse effects
Critical issues: Medications Compliance
40 to 60% of patients do not take their medications
Adverse Effects 2 to 4% of hospital admissions drug related Greater 30% in patients 75 years or older 10.4% of GP patients in previous 6 months
Poly-pharmacy Patients of more than 5 medications
Resistance in a specific disease: Cancer
Role of the Pharmacist
Quality use of medicines Consumer Medication Information Compliance (DAA) Clinical Intervention (Meds check) Home Medication Review (HMR) Residential Review (RMMR) Basic and clinical research
MedsCheck: Medicines Review Program In-pharmacy, patient centred service: aims
to enhance the quality use of medicines: educating community based patients about
their medicines identifying any problems they may be
experiencing with their medicines; and understanding interactions between
medicines.
Compliance
Prescription not filledPRIMARY NON-COMPLIANCE
Decision to prescribePatient receives the advice/
recommendation to use a given Rx
Prescription filledThe initial prescription is filled by the
patient
Not refilledSECONDARY NON-COMPLIANCE
Not takenSECONDARY NON-COMPLIANCE
INTENTIONALNON-COMPLIANCE
UNINTENTIONALNON-COMPLIANCE
INTENTIONALNON-COMPLIANCE
UNINTENTIONALNON-COMPLIANCE
Source : PSA 2006
Horne et al (2006)
NecessityBeliefs need for medication to maintain/improve current
and future health
ConcernsArising from the belief
about potential negative effects
Specific BeliefsViews about the prescribed medication
Home Medication Reviews (HMR)available to people living in the community
setting where their medical practitioner determines that an HMR is clinically necessary to ensure quality use of medicines or to address the consumer’s needs.
Aims of HMR Take your medicines correctly Explaining why and when Storage What to expect when taking them What problems you should report to the GP Checking that prescription medicines, over-the-counter
medicines and vitamins are appropriate to take together Clarifying any confusion with generic medicines Compliance Changing your medicines.
Source:Http://www.nps.org.au/consumers/ask_an_expert/home_medicine_review
Eligibility for HMR Source : NPS
Numbers of HMRs Over Time
2002
2003
2004
2005
2006
2007
2008
2009
2010
14635
21734
22656
25073
26687
33849
40105
48501
52201
Castelino, Bajorek & Chen. Journal of Evaluation in Clinical Practice , 17,(20110 104-110.
N= 224 964 recommendations
ConclusionMedicines have great benefits but “ care”
Greatest at risk group , over 65 with more than 5 medications
Ask questions about your medications to health care professional
Shared Responsibility
